ABSTRACT
IgG4-related disease-associated hypertrophic pachymeningitis (IgG4RD-HP) is a fibroinflammatory autoimmune disorder in which diagnosis is difficult without biopsy. Guidance on management of disease refractory to glucocorticoids and intravenous rituximab is limited. We present the case of a 68-year-old woman with IgG4RD-HP who developed sensorineural hearing loss with associated bulky basilar pachymeningeal enhancement. Her cerebrospinal fluid was inflammatory and had an elevated IgG4 concentration, strongly suggestive of IgG4RD-HP. Biopsy of involved meninges was not possible due to surgical risk. Over years she developed bilateral optic neuropathies and hydrocephalus, requiring intravenous rituximab and ventriculoperitoneal shunt. Her disease was refractory to glucocorticoids. Despite maintenance intravenous rituximab, she developed slowly progressive symptoms of intracranial hypertension and hydrocephalus with persistently inflammatory spinal fluid. Switching to intrathecal rituximab therapy led to dramatic improvement in gait and headache and reduced pachymeningeal bulk and metabolic activity. In patients with IgG4RD-HP refractory to glucocorticoids and intravenous rituximab, intrathecal rituximab may be an efficacious therapy.
ABSTRACT
Carcinoid tumors are uncommon in children. Kidneys are rarely involved as they do not possess neuro-endocrine cells. Work up of painless hematuria after abdominal trauma in a 10-year-old boy revealed primary carcinoid tumors with metastasis to both kidneys. We were unable to find any previous reports of renal involvement by carcinoid tumor in children.
Subject(s)
Carcinoid Tumor/secondary , Jejunal Neoplasms/pathology , Kidney Neoplasms/secondary , Kidney/pathology , Biopsy , Carcinoid Tumor/therapy , Child , Fatal Outcome , Hematuria/pathology , Humans , Jejunal Neoplasms/therapy , Kidney Neoplasms/therapy , Lung Neoplasms/secondary , Lung Neoplasms/therapy , Male , Young AdultABSTRACT
Toriello-Carey syndrome (TCS) is a multiple congenital anomaly syndrome of unknown etiopathogenesis with characteristic findings including corpus callosum defects, minor facial dysmorphisms, mental retardation, postnatal growth delays, cardiac defects, limb anomalies and genitourinary defects in affected males. This report describes two siblings with features of the TCS in whom array comparative genomic hybridization detected both a 3q29 microduplication as well as a 6p25 microdeletion due to an unbalanced translocation inherited from the father. Though neither microscopic copy number imbalance has been previously attributed to the TCS, this report supports the assertion that roughly 25% of patients with presumed TCS by phenotype may harbor underlying cytogenetic aberrations. Further, this report maintains that, until the specific causative gene is identified, a diagnosis of TCS be reserved for those patients who have not only the salient clinical features but also normal genetic studies that should include microarray.
Subject(s)
Agenesis of Corpus Callosum , Craniofacial Abnormalities/genetics , Heart Defects, Congenital/genetics , Siblings , Abnormalities, Multiple/genetics , Abnormalities, Multiple/pathology , Adolescent , Child , Chromosome Deletion , Chromosome Duplication , Chromosomes, Human, Pair 3 , Chromosomes, Human, Pair 6 , Corpus Callosum/pathology , Craniofacial Abnormalities/complications , Fathers , Female , Genetic Heterogeneity , Heart Defects, Congenital/complications , Humans , Intellectual Disability/etiology , Intellectual Disability/genetics , Intellectual Disability/pathology , Male , Phenotype , Syndrome , Translocation, GeneticABSTRACT
Congenital insensitivity to pain and anhidrosis (CIPA) is one of the hereditary autonomic and sensory neuropathies. Typically presenting in infancy, it manifests as hyperpyrexia from defects in sweating (autonomic) and self-mutilating injuries from pain insensitivity (sensory). CIPA being rare in North America, diagnosis is often missed due to variable presentation. Subsequent management of its complications is therefore delayed. We report an unusual presentation in a 2-year-old girl with preexisting diagnosis of CIPA who was evaluated for bilateral upper extremity paresis of insidious onset. MRI revealed a mass compressing her cervical spine as the cause, and work up suggested immune dysfunction as possible etiology. To our knowledge, this complication has not been reported before in association with the disease. We introduce the disease by explaining the molecular pathology behind its presenting features. The neurological findings, documented in association with CIPA, are summarized and serve as a reference for the various presentations of this rare disorder. Since this disease is known to affect the immune system, immune defects in CIPA are discussed with recommendations for surveillance of patient's immune status.